LAUSR

Glaucoma associated with penetrating keratoplasty (PK) is a major cause of graft failure and irreversible visual loss.[1,2] Post‐penetrating keratoplasty glaucoma (PPKG) is a significant clinical challenge due to difficulty in diagnosis, accurately measuring and monitoring IOP as well as complexity in its management. It leads to significant endothelial cell loss as the endothelial reserve is already low in a recipient corneal graft. Needless to say, appropriate diagnosis and treatment are essential to preserve the clarity of the corneal graft as well as optic nerve function. The incidence of glaucoma following PK has been reported to be between 9% and 35%.[3] Few studies in India have reported on glaucoma following PK despite corneal diseases, including infectious keratitis and penetrating trauma, being a major cause of visual loss and PK being one of the most common surgical procedures to address corneal blindness.[4,5] Post‐PK glaucoma is likely to be less common in the West and economically advanced nations owing to the preponderance of non‐inflammatory corneal diseases such as keratoconus, corneal dystrophies, and ectasia as predominant indications of PK. In less‐developed economies such as Asia and Africa, infectious keratitis, penetrating trauma with significant peripheral anterior synechiae (PAS) and bullous keratopathy associated with complicated cataract surgeries are likely to be more common indications of PK with an estimated higher incidence of post‐PK glaucoma. Outcomes of cataract surgery have significantly improved in India in the past three decades, with lower incidence of corneal complications, and the quality of graft clarity has significantly improved with lamellar keratoplasty techniques. Due to the paucity of published studies, it is not known if these improvements in outcomes of ocular surgeries and early diagnosis and management of infective keratitis have reduced the occurrence of post‐PK glaucoma. Preexisting glaucoma, regrafts, peripheral anterior synechiae, and prolonged steroid therapy are major risk factors for post‐PK IOP elevation or glaucoma.[6]